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      Choroidal Macrovessel Diagnosed on Multimodal Imaging, including Swept-Source Optical Coherence Tomography Angiography

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          Abstract

          Choroidal macrovessel (CM) is a rare anomalous vascular lesion in the choroid. In this case report, we describe a 72-year-old Caucasian man diagnosed with an incidental heavily branching CM in the macula of his right eye based on multimodal imaging, including enhanced depth imaging optical coherence tomography (OCT), swept-source OCT angiography, and indocyanine green angiography. Multimodal imaging is valuable in demonstrating the distinctive appearance of this entity and differentiating it from more vision-threatening differential diagnoses, such as ophthalmomyiasis interna, choroidal neoplasms, retinochoroidal anastomosis, and inflammatory conditions.

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          Most cited references11

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          Quantitative optical coherence tomography angiography of vascular abnormalities in the living human eye.

          Retinal vascular diseases are important causes of vision loss. A detailed evaluation of the vascular abnormalities facilitates diagnosis and treatment in these diseases. Optical coherence tomography (OCT) angiography using the highly efficient split-spectrum amplitude decorrelation angiography algorithm offers an alternative to conventional dye-based retinal angiography. OCT angiography has several advantages, including 3D visualization of retinal and choroidal circulations (including the choriocapillaris) and avoidance of dye injection-related complications. Results from six illustrative cases are reported. In diabetic retinopathy, OCT angiography can detect neovascularization and quantify ischemia. In age-related macular degeneration, choroidal neovascularization can be observed without the obscuration of details caused by dye leakage in conventional angiography. Choriocapillaris dysfunction can be detected in the nonneovascular form of the disease, furthering our understanding of pathogenesis. In choroideremia, OCT's ability to show choroidal and retinal vascular dysfunction separately may be valuable in predicting progression and assessing treatment response. OCT angiography shows promise as a noninvasive alternative to dye-based angiography for highly detailed, in vivo, 3D, quantitative evaluation of retinal vascular abnormalities.
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            Dark Signals in the Choroidal Vasculature on Optical Coherence Tomography Angiography: An Artefact or Not?

            Optical coherence tomography angiography (OCTA) based on mathematical processing of sequentially acquired structural OCT images has been applied widely in both retinal and choroidal research and may have advantages over traditional angiography. Images obtained by OCTA are rendered under the assumption that the only moving entity in the retina is blood flow. Optical phenomena and image processing algorithms may create imaging artefacts. Therefore, OCTA images require careful interpretation. This review discusses the dark signals seen in the choroidal vasculature on OCTA using multiple factor analysis. For accurate and comprehensive interpretation of the choroidal vasculature, we recommend simultaneous consideration of the laser light penetration depth and masking effect of retinal pigment epithelium, the orientation of vessels in relation to the scanning lasers and blood flow, the range of regional detectable velocity of blood flow, atrophic tissues in the periphery, and absorption of superior vessels on the scanning laser.
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              Choroidal macrovessel.

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                Author and article information

                Journal
                Case Rep Ophthalmol
                Case Rep Ophthalmol
                COP
                Case Reports in Ophthalmology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1663-2699
                Jan-Apr 2022
                24 March 2022
                24 March 2022
                : 13
                : 1
                : 215-219
                Affiliations
                [1] aDivision of Ocular Immunology and Uveitis, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
                [2] bRetina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
                Author notes
                *J. Fernando Arevalo, arevalojf@ 123456jhmi.edu
                Article
                cop-0013-0215
                10.1159/000521895
                9082210
                2072c343-d683-4e12-9a3b-f34797de97a2
                Copyright © 2022 by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 3 October 2021
                : 26 December 2021
                : 2022
                Page count
                Figures: 2, References: 11, Pages: 5
                Categories
                Case Report

                choroidal macrovessel,swept-source optical coherence tomography angiography,choroid-scleral junction,aberrant posterior ciliary artery,fringe washout artifact

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